The Shifting Toll Of America’s Drug Epidemic

The typical overdose victim is becoming younger and more urban

EVERY 25 minutes an American baby is born addicted to opioids. The scale of both use and abuse of the drugs in the United States is hard to overstate: in 2015, the most recent year for which figures are available, an estimated 38% of adults took prescription opioids. Of those, one in eight (11.5m people in total) misused their prescription. Around 1m Americans overdosed last year, and 64,000 of them died.

The scourge of opioid abuse gained political salience last year, as voters in parts of the country with high levels of drug overdoses swung strongly towards Donald Trump. The president has taken few steps to combat the opioid crisis since taking office, but on October 26th he is expected to direct his secretary of health and human services to declare a public-health emergency. His national drug commission is due to publish a report on November 1st recommending a mix of rehabilitation, awareness-building and policing as the best response the epidemic.

Politically, it stands to reason that Mr Trump would show interest in the opioid crisis, given that press reports paint the typical abuser as an archetypal older, rural Trump voter, perhaps with a prescription to treat back pain. Yet the government runs the risk of fighting the last war in its effort to quell the epidemic, because the causes and victims of drug overdoses in America are changing fast.

The number of deaths from prescription opioids has continued to rise, from around 11,000 in 2013 to 15,000 a year now. But the rate of growth has slowed, and many forecasters predict it may be nearing its peak. By contrast, the toll from fentanyl, a synthetic opioid 50 times stronger than heroin, is soaring. After claiming just 3,000 lives in 2013, it killed 22,000 people in America last year, more than either heroin or prescription opioids. Deaths from heroin have become far more frequent as well: after being roughly a quarter as common as fatal prescription overdoses in the mid-2000s, they overtook deaths from prescription opioids in 2015.

This change in the leading causes of opioid-related deaths has been accompanied by a shift in the profile of the average victim. The highest rates of prescription-opioid abuse can be found among middle-aged rural whites, including women. By contrast, both fentanyl and heroin users tend to be much younger, more likely to live in cities, somewhat more racially diverse and overwhelmingly male (see heat map above). Reaching people at high risk of exposure to these more potent opioids cannot be done by offering services to former Rust Belt factory workers or Appalachian coal miners, but will require a different approach.

Similarly, most media attention has focused on substance abuse in states Mr Trump won, such as West Virginia, Kentucky and Ohio. But blue states like Maryland, Delaware and Massachusetts also figure among the current top ten for deaths from drug overdoses. That means Mr Trump will need to extend the government’s efforts far beyond his electoral base if he hopes to address the opioid epidemic.